1437221504 NPI number — PRAIRIE COMMUNITY HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437221504 NPI number — PRAIRIE COMMUNITY HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAIRIE COMMUNITY HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437221504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABEL
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57633-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE BUTTE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-964-7920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERSON
Authorized Official First Name:
BILLIE RAE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
605-466-2120

Provider Taxonomy Codes

  • Taxonomy code: 363LS0200X , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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